Aa
GHSV1? HSV2? None?
Had an "initial OB" on mar 2009 (9 weeks after vaginal sex with partner A, 2 weeks after oral/vaginal sex with partner B). Bilateral, widespread sores that looked like canker sores. Got flu symptoms, but they had subsided before I spotted the sores. Doctor said it wasn't a typical initial outbreak (too widespread, she said) and that incubation period was not right, but gave me Famvir anyway. The “OB” lasted 1.5 weeks tops.
5 days after onset I had a PCR swab (one from a lesion, another from the cervix) -> negative for HSV. I was not on antivirals.
2 weeks after onset, I tested HSV1+, HSV2- (glycoprotein based test). And I've been getting the same result since then. Last exam was on June 2010. I'm not on suppressive therapy.
The problem is that I had "two recurrences". (a) Jan 2010, a open sore next to my hairline in labia majora (dermatologist said it healed too quick to be herpes, said it could have been foliculitis - healed completely in 5 days); (b) Jun 2010, consisting of two ulcers - one in left labia minora and other in majora - confirmed by a GYN, lasted a week. Coincidence or not, all my "obs" happened right after an episode of sore throat.
Apart from that, I frequently experience muscle fasciculation in my legs, buttocks and groins (prodomes?).
As you can notice, I'm having trouble trying to understand what's going on: Genital HSV1, HSV2 or none of them. Both my partners tested 4 months after our encounter - partner A (one-time partner) tested negative for HSV IgG using one of those antigen based tests but there's a rumor about one of his former partners having gherpes (not confirmed by him); partner B (6-year partner) tested HSV1+ HSV2-, has no history of noticeble cold sores. Both partners showed me their results.
I don't have access to WB. I'll certainly try the PCR swab again, but in the meantime, from your experience, what should I make of all this? My doctor says I have herpes, but it seems like there's a conjecture of improbabilities in my case.
5 days after onset I had a PCR swab (one from a lesion, another from the cervix) -> negative for HSV. I was not on antivirals.
2 weeks after onset, I tested HSV1+, HSV2- (glycoprotein based test). And I've been getting the same result since then. Last exam was on June 2010. I'm not on suppressive therapy.
The problem is that I had "two recurrences". (a) Jan 2010, a open sore next to my hairline in labia majora (dermatologist said it healed too quick to be herpes, said it could have been foliculitis - healed completely in 5 days); (b) Jun 2010, consisting of two ulcers - one in left labia minora and other in majora - confirmed by a GYN, lasted a week. Coincidence or not, all my "obs" happened right after an episode of sore throat.
Apart from that, I frequently experience muscle fasciculation in my legs, buttocks and groins (prodomes?).
As you can notice, I'm having trouble trying to understand what's going on: Genital HSV1, HSV2 or none of them. Both my partners tested 4 months after our encounter - partner A (one-time partner) tested negative for HSV IgG using one of those antigen based tests but there's a rumor about one of his former partners having gherpes (not confirmed by him); partner B (6-year partner) tested HSV1+ HSV2-, has no history of noticeble cold sores. Both partners showed me their results.
I don't have access to WB. I'll certainly try the PCR swab again, but in the meantime, from your experience, what should I make of all this? My doctor says I have herpes, but it seems like there's a conjecture of improbabilities in my case.
MEDICAL PROFESSIONAL
All evidence considered, your negative PCR test was valid, i.e. true-negative not false-negative.
That's definitely all for this thread. Please try hard to accept the reassurance; stop looking for ways to convince me (and yourself) that you really have herpes. You do not and that's all there is to it.
That's definitely all for this thread. Please try hard to accept the reassurance; stop looking for ways to convince me (and yourself) that you really have herpes. You do not and that's all there is to it.
Thank you, Dr. HHH. I might be asking too much, but could you address the PCR question I made above (Oct 27)? You left it out of your answer. As I said, I'm seeing a vulva expert within a few days and I would like to able to show her my PCR swab result without fearing there's a possibility of false-negative.
Thank you very much. Sorry for the delay, I was travelling abroad.
Thank you very much. Sorry for the delay, I was travelling abroad.
MEDICAL PROFESSIONAL
Equivocal or low-positive HSV-2 results are very common in people with positve results for HSV-1, which explains the first test results you cite above. The HSV-2 result is clearly negative in the second set of tests. Taken together, these results are exceedingly strong evidence you do not have HSV-2. (The lower HSV-1 result doesn't mean anything. The numerical value can vary widely among persons with HSV-1 antibody.)
Taking all the evidence into account, you can go forward with complete certainty you are not infected with HSV-2. It remains possible you have genital herpes due to HSV-1, but if you do, most likely there will be few if any recurrent outbreaks and the chance of sexual transmission to a partner will be low.
That will have to end this thread. Take care.
Taking all the evidence into account, you can go forward with complete certainty you are not infected with HSV-2. It remains possible you have genital herpes due to HSV-1, but if you do, most likely there will be few if any recurrent outbreaks and the chance of sexual transmission to a partner will be low.
That will have to end this thread. Take care.
If a new post is needed, please let me know.
Oh, and just another information that I left out in my report that I'm not sure if it is relevant. Over a month after my "initial OB" I had a HerpeSelect stating HSV1 IgG 3.3 and HSV2 1.1 (equivocal). At the time, I obviously thought I was seroconverting for HSV2, but since then I had two other exams that were negative for HSV2, with a slight decrease in HSV1 titers - HSV1IgG 1.3 and HSV2 IgG 0.6; HSV2 IgG 0.41. Any reason to worry about that equivocal result?
Dr. HHH, if you allow me I'd like to ask you a final question. I made an appointment with a vulva specialist and I just wanted to make sure that I have all the necessary info to talk to her. There's a question that I forgot to ask.
As I wrote above, I had a PCR swab 5 days after I first noticed the vaginal sores that came back negative for HSV. Such sores would most probably be my initial infection if I happened to have herpes, since they were bilateral and multiple (around 6 sores or so) - correct me if I'm wrong.
During my first consultation to the GYN, she thought my sores were caused by yeast (?) and prescribed me a topical antifungical/antibiotic and also one of those powder that you dissolve and wash your vagina with (benzydamine, a NSAID). I used them till the sores became open sores (that would be day 3 or 4) and I'm not sure if such medications would have the power to give a false-negative in a PCR swab. I tend to think they would not influence the result since they are not antivirals and specially during an initial infection, but do you think this is a relevant nfo I should take into account? I imagine you have dealt with many, many PCR swab results, I would apprecciate your thoughts about such scenario.
Thank you very much.
As I wrote above, I had a PCR swab 5 days after I first noticed the vaginal sores that came back negative for HSV. Such sores would most probably be my initial infection if I happened to have herpes, since they were bilateral and multiple (around 6 sores or so) - correct me if I'm wrong.
During my first consultation to the GYN, she thought my sores were caused by yeast (?) and prescribed me a topical antifungical/antibiotic and also one of those powder that you dissolve and wash your vagina with (benzydamine, a NSAID). I used them till the sores became open sores (that would be day 3 or 4) and I'm not sure if such medications would have the power to give a false-negative in a PCR swab. I tend to think they would not influence the result since they are not antivirals and specially during an initial infection, but do you think this is a relevant nfo I should take into account? I imagine you have dealt with many, many PCR swab results, I would apprecciate your thoughts about such scenario.
Thank you very much.
No, she was not joking! She was just trying to find an explanation for me to have HSV2 when both my partners tested HSV2-.
Funny thing is that the first time I went to her office (when I spotted the sores), she said "no way it's herpes, never seen purple sores like that in herpes". But a few days later, when urinating became painful, she said "well, probably herpes, good to know that it looks like purple sores before turning into white sores". I mean, she's so sure it's herpes now (despite me never having a positive result) but at first she wasn't.
I do believe that I most certainly do not have HSV2 - your remarks on the matter were decisive. And I'll try the PCR swab again, but hopefully I won't have to deal with recurrences. As for my partner(s) getting tested, they already did it 4 months after exposure, as I wrote above.
If I happen to have a PCR swab results in hand, I'll open another thread. Thanks again.
Funny thing is that the first time I went to her office (when I spotted the sores), she said "no way it's herpes, never seen purple sores like that in herpes". But a few days later, when urinating became painful, she said "well, probably herpes, good to know that it looks like purple sores before turning into white sores". I mean, she's so sure it's herpes now (despite me never having a positive result) but at first she wasn't.
I do believe that I most certainly do not have HSV2 - your remarks on the matter were decisive. And I'll try the PCR swab again, but hopefully I won't have to deal with recurrences. As for my partner(s) getting tested, they already did it 4 months after exposure, as I wrote above.
If I happen to have a PCR swab results in hand, I'll open another thread. Thanks again.
MEDICAL PROFESSIONAL
I take back my previous comment about your provider perhaps undersanding genital herpes well. Assuming you are accurately relating what she said, her thoughts range from simply wrong to overtly bizarre.
"incubation period might be as longer than 2 months"? The true incubation period cannot be that long. It is possible to have an initial infection with no symptoms, and then have a recurrent outbreaks starting a few weeks or even a few years later. In this way, the incubation period can seem to be a few weeks, months or even several years. If the initial infection causes symptoms at all, they always start within 3 weeks and usually just a few days.
HSV serology is not all that "tricky". With the modern tests, it's quite straightforward and easy to understand. Your results are clear: you have HSV-1, as does half the population, and not HSV-2.
Can a man be exposed to HSV-2, have it on his penis, not infected, and transmit it to another person? Absolutely not -- unless maybe if he were in a group sex situation and moved immediately (within a minute or two) from a partner with active HSV-2 infection and then contaminated another partner with the first partner's vaginal secretions. But your doctor's explanation is just plain silly: it is not possible for someone to have HSV-2 survive on his or her genitals, and be able to transmit it to another person without ever being infected him/herself, and without getting a positive blood test.
Contaminated toilet seats, towels, shared underwear, etc used to be used commonly to explain STDs in people seemingly at low risk. It was a face-saving way for physicians (typically male) to explain to the wives of their male patients why she had to be treated for gonorrhea, syphilis, etc without raising the notion that either one of them had other partners. The untruth of the theory was pretty widely understood by experts a hundred years ago, and nobody believes it today -- especially since recent research has explained how many STDs can show up long after exposure, or be transmitted without symptoms in monogamous couples. I'm rather amazed that you found a physician in the 2000s who actually was able to suggest this with a straight face. Are you sure she wasn't snickering behind your back? (Not really -- pardon the joke -- but this is exactly that bizarre.)
I also agree in part that your partner's absence of recognized oral herpes argues against him being the source of your HSV-1 infection. But as I said, I don't think you have genital herpes at all; and am suspicious that your positive HSV-1 blood test goes backt a distant past (unrecognized) infection, probably oral, perhaps in childlhood. On the other hand, your doctor is wrong to suggest that absence of oral herpes rules out any chance he infected you. Many, many people catch gential herpes -- either HSV-1 or HSV-2 -- from infected partners who have had no known symptoms of herpes, oral or genital. But anyway,
The only obviously accurate statement that you report is that HSV-2 indeed is the most common cause of certain kinds of recurrent genital sores. But only if those sores themselves are reasonably typical -- and their are many, many exceptions. That fact alone never establishes herpes as the cause despite negative lab testing.
Please carefully read all my replies to try to understand that you most likely do not have genital herpes and never did; that if you do, it is caused by HSV-1, in which case it could have been caught from a recent partner or perhaps someone else in your sexual past; and that almost certainly you do not have HSV-2. This opinion is based on a combination of several elements of your story, whereas your doctor's reasoning about it is based on false assumptions and misunderstandings.
As I said above, you could attempt a test for the virus (culture or, preferably, PCR) within 1-2 days if/when you have another apparent genital outbreak. You could also arrange for your partner to be tested for HSV-1 and -2, which would tell you for sure which virus(es) you might have been exposed to.
Your instinct to educate your own doctor about herpes is admirable. But based on what you have said here, I'm afraid it may be a lost cause. In any case, that will have to end this thread, unless and until you get more definitive lab test results that sort this out one way or the other.
Best wishes.
"incubation period might be as longer than 2 months"? The true incubation period cannot be that long. It is possible to have an initial infection with no symptoms, and then have a recurrent outbreaks starting a few weeks or even a few years later. In this way, the incubation period can seem to be a few weeks, months or even several years. If the initial infection causes symptoms at all, they always start within 3 weeks and usually just a few days.
HSV serology is not all that "tricky". With the modern tests, it's quite straightforward and easy to understand. Your results are clear: you have HSV-1, as does half the population, and not HSV-2.
Can a man be exposed to HSV-2, have it on his penis, not infected, and transmit it to another person? Absolutely not -- unless maybe if he were in a group sex situation and moved immediately (within a minute or two) from a partner with active HSV-2 infection and then contaminated another partner with the first partner's vaginal secretions. But your doctor's explanation is just plain silly: it is not possible for someone to have HSV-2 survive on his or her genitals, and be able to transmit it to another person without ever being infected him/herself, and without getting a positive blood test.
Contaminated toilet seats, towels, shared underwear, etc used to be used commonly to explain STDs in people seemingly at low risk. It was a face-saving way for physicians (typically male) to explain to the wives of their male patients why she had to be treated for gonorrhea, syphilis, etc without raising the notion that either one of them had other partners. The untruth of the theory was pretty widely understood by experts a hundred years ago, and nobody believes it today -- especially since recent research has explained how many STDs can show up long after exposure, or be transmitted without symptoms in monogamous couples. I'm rather amazed that you found a physician in the 2000s who actually was able to suggest this with a straight face. Are you sure she wasn't snickering behind your back? (Not really -- pardon the joke -- but this is exactly that bizarre.)
I also agree in part that your partner's absence of recognized oral herpes argues against him being the source of your HSV-1 infection. But as I said, I don't think you have genital herpes at all; and am suspicious that your positive HSV-1 blood test goes backt a distant past (unrecognized) infection, probably oral, perhaps in childlhood. On the other hand, your doctor is wrong to suggest that absence of oral herpes rules out any chance he infected you. Many, many people catch gential herpes -- either HSV-1 or HSV-2 -- from infected partners who have had no known symptoms of herpes, oral or genital. But anyway,
The only obviously accurate statement that you report is that HSV-2 indeed is the most common cause of certain kinds of recurrent genital sores. But only if those sores themselves are reasonably typical -- and their are many, many exceptions. That fact alone never establishes herpes as the cause despite negative lab testing.
Please carefully read all my replies to try to understand that you most likely do not have genital herpes and never did; that if you do, it is caused by HSV-1, in which case it could have been caught from a recent partner or perhaps someone else in your sexual past; and that almost certainly you do not have HSV-2. This opinion is based on a combination of several elements of your story, whereas your doctor's reasoning about it is based on false assumptions and misunderstandings.
As I said above, you could attempt a test for the virus (culture or, preferably, PCR) within 1-2 days if/when you have another apparent genital outbreak. You could also arrange for your partner to be tested for HSV-1 and -2, which would tell you for sure which virus(es) you might have been exposed to.
Your instinct to educate your own doctor about herpes is admirable. But based on what you have said here, I'm afraid it may be a lost cause. In any case, that will have to end this thread, unless and until you get more definitive lab test results that sort this out one way or the other.
Best wishes.
Just an update: I went to the GYN for my annual pap smear and I told her about your views on my episodes of genital ulceration. She said a couple of things that confused me though.
She still tends to believe I have HSV2 because it's the most common cause of such episodes. I told her about your remarks (such as "9 weeks is way too long from exposure to initial symptoms", the fact that me and my both partners tested negative for HSV2 IgG and my negative PCR swab) and she replied that she was quite sure that there are studies that showed that incubation period might be as longer than 2 months (I found a study called "Does first episode genital herpes have an incubation period? A clinical study." in PubMed, I'm thinking it might be this one.)
As for the results, she said that sorology is "tricky" for HSV2 and the fact that I have HSV1 might be slowing my antibody production and might explain my delayed symptoms onset. (?) Concerning the PCR swab, she said that my initial infection was so mild (like 6, 7 sores) that the virus shedding after 5 days could have been undetectable already.
Other thing that confused me was her statement that I might have caught HSV2 from Partner A even if his sorology is negative. She said that if he had the virus in his penis by the time of exposure (catching it from a recent previous partner), he could have transmited the virus to me without having it. The virus was on his penis trying to enter his body, but he successfully fought it and was not infected permanentely. (?) She also brought up the "public toilet" theory of transmission, which I'm aware is not possible.
I told her that it could be HSV1, but she pointed out that my boyfriend has never had a noticeble cold sore in adult life and thus transmission would be unlikely.
I certainly want to educate her on those matters next time I see her. Does she have a point at all? She brought so many new info that I'm even more confused!
She still tends to believe I have HSV2 because it's the most common cause of such episodes. I told her about your remarks (such as "9 weeks is way too long from exposure to initial symptoms", the fact that me and my both partners tested negative for HSV2 IgG and my negative PCR swab) and she replied that she was quite sure that there are studies that showed that incubation period might be as longer than 2 months (I found a study called "Does first episode genital herpes have an incubation period? A clinical study." in PubMed, I'm thinking it might be this one.)
As for the results, she said that sorology is "tricky" for HSV2 and the fact that I have HSV1 might be slowing my antibody production and might explain my delayed symptoms onset. (?) Concerning the PCR swab, she said that my initial infection was so mild (like 6, 7 sores) that the virus shedding after 5 days could have been undetectable already.
Other thing that confused me was her statement that I might have caught HSV2 from Partner A even if his sorology is negative. She said that if he had the virus in his penis by the time of exposure (catching it from a recent previous partner), he could have transmited the virus to me without having it. The virus was on his penis trying to enter his body, but he successfully fought it and was not infected permanentely. (?) She also brought up the "public toilet" theory of transmission, which I'm aware is not possible.
I told her that it could be HSV1, but she pointed out that my boyfriend has never had a noticeble cold sore in adult life and thus transmission would be unlikely.
I certainly want to educate her on those matters next time I see her. Does she have a point at all? She brought so many new info that I'm even more confused!
MEDICAL PROFESSIONAL
The older (non-type specific) HSV blood tests are difficult to interpret if positive for either HSV-1 or 2. But a negative result is very reliable evidence against both infections.
Thanks for the explanation re the sulfa-relatedness of some NSAIDs. That sounds right.
Thanks for the explanation re the sulfa-relatedness of some NSAIDs. That sounds right.
Thanks for the answers.
(2) Just to clearify, partner A had one of those older ELISA tests that are not based on glycoprotein and it was negative for both HSV1 and HSV2, IgG and IgM. Sorry for the confusion.
(3) As for the FDE theory, she told me that the NSAIDs I took are sulfa non-steroidal anti-inflammatory drugs (COX2 inhibitors); therefore, they might cause the same adverse effects as sulfonamides antibiotics. One of them was actually banned in the US. Well, it's a theory, might be just as improbable as me having herpes.
I guess my latest infos won't change much your previous input. Thanks a lot and keep up the good work.
(2) Just to clearify, partner A had one of those older ELISA tests that are not based on glycoprotein and it was negative for both HSV1 and HSV2, IgG and IgM. Sorry for the confusion.
(3) As for the FDE theory, she told me that the NSAIDs I took are sulfa non-steroidal anti-inflammatory drugs (COX2 inhibitors); therefore, they might cause the same adverse effects as sulfonamides antibiotics. One of them was actually banned in the US. Well, it's a theory, might be just as improbable as me having herpes.
I guess my latest infos won't change much your previous input. Thanks a lot and keep up the good work.
MEDICAL PROFESSIONAL
1) 2 swabs is fine. It's very common to test 2 (or more) lesions, and indeed the price is the same if both swabs are submitted as one sample. This doesn't reduce the likelihood of a positive result -- just the opposite, it increases the yield. (Since your gyn apparently knows this, s/he may not be as clueless about herpes as you have thought.)
2) My guess is that there is a communication problem here. There are no antigen-based blood tests for HSV, only antibody. Assuming he had one of the standard blood tests, probably you can rely on the result. But if you have HSV at all, partner A is not a realistic possibility for your infection -- 9 weeks is way too long from exposure to initial symptoms.
3) It's just possible you have hit on the answer. Ask the dermatologist whether s/he believes a fixed drug eruption could explain your genital lesions -- probably not the first (too many lesions) but perhaps the next two. FDEs are localized allergic reactions that commonly involve the genital area. I'm not aware that NSAIDs have been documented as causes, but sulfonamides ("sulfa drugs") are among the more common causes of FDE. (That said, I can't imagine that any NSAIDs are combined with sulfonamides -- for sure there is no such drug product in the US.)
2) My guess is that there is a communication problem here. There are no antigen-based blood tests for HSV, only antibody. Assuming he had one of the standard blood tests, probably you can rely on the result. But if you have HSV at all, partner A is not a realistic possibility for your infection -- 9 weeks is way too long from exposure to initial symptoms.
3) It's just possible you have hit on the answer. Ask the dermatologist whether s/he believes a fixed drug eruption could explain your genital lesions -- probably not the first (too many lesions) but perhaps the next two. FDEs are localized allergic reactions that commonly involve the genital area. I'm not aware that NSAIDs have been documented as causes, but sulfonamides ("sulfa drugs") are among the more common causes of FDE. (That said, I can't imagine that any NSAIDs are combined with sulfonamides -- for sure there is no such drug product in the US.)
Thanks a lot, Dr. HHH. My GYN has no clue about herpes (in fact, nobody does around here) so it's great to count on your advice. Just a few additional questions that I left out:
1) Is it usual to use two separate swabs for a single PCR test? I mean, do labs test two swabs "for the price of one PCR"? Just trying to understand why a PCR swab during initial infection would be negative.
2) Those antigen based tests for both HSV I and II (combined, as the one used by Partner A) are trustworthy in terms of stating a negative resul? As you can imagine, my first suspicion was catching HSV2 from Partner A, specially because of that rumour regarding his former partner.
3) I'm planning to work this with my dermatologist from now on and she brought to my attention that during those three "obs" I was using NSAIDs that contain sulfa-something (for the sore throat). Just out of curiosity, have you ever seen a case of drug allergy that might mimic herpes sores?
Thanks a lot again and have a nice weekend.
1) Is it usual to use two separate swabs for a single PCR test? I mean, do labs test two swabs "for the price of one PCR"? Just trying to understand why a PCR swab during initial infection would be negative.
2) Those antigen based tests for both HSV I and II (combined, as the one used by Partner A) are trustworthy in terms of stating a negative resul? As you can imagine, my first suspicion was catching HSV2 from Partner A, specially because of that rumour regarding his former partner.
3) I'm planning to work this with my dermatologist from now on and she brought to my attention that during those three "obs" I was using NSAIDs that contain sulfa-something (for the sore throat). Just out of curiosity, have you ever seen a case of drug allergy that might mimic herpes sores?
Thanks a lot again and have a nice weekend.
MEDICAL PROFESSIONAL
Back pain isn't a herpes symptom, and I doubt your slightly aberrant vaginal bacteria is anything to worry about or related at all to the herpes issue.
MEDICAL PROFESSIONAL
Welcome to the forum. I understand your dilemma and will try to help.
Based on your description, it's possible you had initial genital HSV infection a year and half ago, but I am inclined to doubt it. If you did, for sure it was HSV-1. And even if the initial episode was herpes, most likely your subsequent outbreaks were not recurrent herpes outbreaks. Here is my reasoning:
The onset of your symptoms was too late for the genital exposure, and oral to genital HSV-2 transmission is very rare; plus the negative HSV-2 blood tests, both you and your partner. So HSV-2 has been ruled out for sure.
So if it was herpes, it was HSV-1. But there are 3 reasons to doubt it: First, the onset was late for HSV-1; most new herpes infections start causing symptoms within 5 days of exposure. It can take 2 or even 3 weeks, but quite uncommonly. Second, the negative PCR test on lesions that were quite recent (5 days) is pretty strong evidence against it. Third, 2 weeks after exposure is awfully early for a positive blood test result. Certainly there can be exceptions to any one of these factors, but it would be statistically very unusual for all three of them to break the wrong way.
As for the recurrent genital area lesions, I agree with your dermatologist's comment about rapid healing, plus a location that is unusual for recurrent herpes but typical for folliculitis. It is harder for me to judge the cause of the "outbreak" in June. Recurrent herpes oubreaks typically are very localized, so that lesions on both the labia minor and major is not the norm -- although not impossible.
You don't need a Western blot. Your blood test results are definitive: you have HSV-1, either from a distant infection (most likely oral in childhood) but possibly acquired in 3/09; and do not have HSV-2. The only way you are likely to sort this out is by PCR testing of a fresh (no more than 2 days old) genital lesion.
In the meantime, I wouldn't worry much about this. Recurrences are uncommon with HSV-1 genital herpes (most people have only 1-2 recurrences over 2-3 years, then no more) and asymptomatic viral shedding is uncommon. Therefore, genital-to-genital HSV-1 transmission is quite uncommon, so your partner(s) are not likely to be at risk. Further, if you continue with your current partner(s), who already have HSV-1 (or any other HSV-1 infected person), then transmission to such a partner is very unlikely. Most people are immune, or at least highly resistant, to a new infection with HSV of the same type they arelady have.
I hope this helps. Best wishes-- HHH, MD
Based on your description, it's possible you had initial genital HSV infection a year and half ago, but I am inclined to doubt it. If you did, for sure it was HSV-1. And even if the initial episode was herpes, most likely your subsequent outbreaks were not recurrent herpes outbreaks. Here is my reasoning:
The onset of your symptoms was too late for the genital exposure, and oral to genital HSV-2 transmission is very rare; plus the negative HSV-2 blood tests, both you and your partner. So HSV-2 has been ruled out for sure.
So if it was herpes, it was HSV-1. But there are 3 reasons to doubt it: First, the onset was late for HSV-1; most new herpes infections start causing symptoms within 5 days of exposure. It can take 2 or even 3 weeks, but quite uncommonly. Second, the negative PCR test on lesions that were quite recent (5 days) is pretty strong evidence against it. Third, 2 weeks after exposure is awfully early for a positive blood test result. Certainly there can be exceptions to any one of these factors, but it would be statistically very unusual for all three of them to break the wrong way.
As for the recurrent genital area lesions, I agree with your dermatologist's comment about rapid healing, plus a location that is unusual for recurrent herpes but typical for folliculitis. It is harder for me to judge the cause of the "outbreak" in June. Recurrent herpes oubreaks typically are very localized, so that lesions on both the labia minor and major is not the norm -- although not impossible.
You don't need a Western blot. Your blood test results are definitive: you have HSV-1, either from a distant infection (most likely oral in childhood) but possibly acquired in 3/09; and do not have HSV-2. The only way you are likely to sort this out is by PCR testing of a fresh (no more than 2 days old) genital lesion.
In the meantime, I wouldn't worry much about this. Recurrences are uncommon with HSV-1 genital herpes (most people have only 1-2 recurrences over 2-3 years, then no more) and asymptomatic viral shedding is uncommon. Therefore, genital-to-genital HSV-1 transmission is quite uncommon, so your partner(s) are not likely to be at risk. Further, if you continue with your current partner(s), who already have HSV-1 (or any other HSV-1 infected person), then transmission to such a partner is very unlikely. Most people are immune, or at least highly resistant, to a new infection with HSV of the same type they arelady have.
I hope this helps. Best wishes-- HHH, MD
Oh, not sure if it matters but I experienced an annoying lower back pain 48h AFTER SEX with partner A (virus entering?). I also experienced some mild rawness that lasted a couple of days after this particular encounter. I went to the GYN a week later (for a check-up) and she mentioned no abnormalities in my vagina, except for a low count of doederlein bacillus (?).
You are reading content posted in the STDs Forum
Herpes spreads by oral, vaginal and anal sex.
Herpes sores blister, then burst, scab and heal.
STIs are the most common cause of genital sores.
Millions of people are diagnosed with STDs in the U.S. each year.
STDs can't be transmitted by casual contact, like hugging or touching.
Syphilis is an STD that is transmitted by oral, genital and anal sex.
